Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Only a small proportion of patients with obesity who are eligible to be screened for bariatric surgery actually get screened.

Note that the reasons for the lack of screening are not known, but could be from shifting standards of what a normal weight is, lack of awareness about the safety and benefits of bariatric surgery, or viewing obesity as a lifestyle problem rather than a disease.

ORLANDO -- Only a small proportion of patients with obesity who are eligible to be screened for bariatric surgery actually get screened, researchers reported here.

Among 42,710 patients with a body mass index (BMI) of 40 kg/m2 or higher, only 2.3% were screened for bariatric surgery. And among 34,283 patients with a BMI of 35 to <40 kg/m2 who were eligible for screening and had several comorbidities, only 19.5% were screened, according to Ahmad Yehya, MD, and Rudruidee Karnchanasorn, MD, at the University of Kansas School of Medicine in Kansas City.

"We were expecting the numbers of patients screened for bariatric surgery to be low, but not that low," Yehya said in an interview with MedPage Today, adding that he and his co-author are trying to make screening for bariatric surgery a health maintenance tool to improve outcomes "both medically and financially."

They used a HERON database to search for patients who met the screening criteria for bariatric surgery at an outpatient clinic during 2014. Independent variables included predisposing characteristics (sex, age, race, marital status) and enabling characteristics (being seen by family medicine or internal medicine physicians). These variables were analyzed through the REDCap database.

For the patients with a BMI of 35 to <40 kg/m2, only 2% with hypertension were screened as were 1.9% with hyperlipidemia, 2.25% with diabetes, and 10% with obstructive sleep apnea. The mean patient age was 57, 66% were female, 72% were Caucasians, and 58% were married.

Tom Rifai, MD, of the Henry Ford Health System in Detroit, said that the percentages were "pretty abysmal," adding that BMI isn't really considered to be a vital sign the way it should be. Rifai, who was not associated with the study, said that BMI can be imperfect, but that is still important.

Assessing BMI "should be a part of every visit," he said.

Yehya noted that older patients were less likely to be screened, perhaps because they have other comorbidities at higher rates and aren't good candidates for surgery. Women are "perhaps more aware of what is going on, and more likely to care about their body appearance and image," he said, thus explaining why they were screened more often. Caucasians may have gotten screened more often because they saw doctors more frequently, he said.

"Awareness plays a role, but insurance does as well," Yehya added. "Bias from doctors could also be a contributing factor."

Jeff Genaw, MD, also of the Henry Ford Health System, said that shifting standards of what a normal weight is might account for the perception that only morbidly obese patients need to be screened. "Since people have gotten bigger and bigger, physicians may have a viewpoint that normal is being 50-60 lbs overweight," he said.

There has also been a shift within the last decade or so viewing obesity as a disease rather than as a lifestyle choice, Genaw explained, but physicians still often treat obesity as a lifestyle problem so there's no need to refer patients to bariatric surgery.

"They often just don't appreciate how difficult it is for people who are morbidly obese to obtain weight loss and keep it off," he said.

Another issue might be a lack of awareness about the safety and benefits of bariatric surgery, which can extend beyond weight loss to improving symptoms of diabetes and metabolic syndrome, Genaw pointed out. "Treating metabolic components is important even if you believe that the patient's weight is theirs to deal with," he said.

When he has spoken with primary care physicians, Genaw said he's been told that patients express concern that bariatric surgery is dangerous, or that their insurance won't cover the procedure, or that it simply involves too much paperwork.

Yehya said that he is working on a questionnaire for primary care physicians to determine how much they know about bariatric surgery. "We are going to ask them about who fits the criteria, and I'd suspect that most of them don't fully know," he said.

Yehya and Karnchanasorn disclosed no relevant relationships with industry.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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